Anti-Müllerian hormone or AMH hormone levels are often tested to check the ovarian reserve in a woman. AMH plays an important role in the development of your sex organs at birth but it’s after puberty that it really becomes a test for fertility in women.
This hormone is produced in the testicles of boys, preventing the development of female sex organs while in girls, the AMH remains low before puberty, thus allowing their sex organs to develop.
After puberty, AMH levels in men begins to taper down. On the other hand, when women hit puberty, their ovaries start making AMH and it becomes an indicator of the ovarian reserve. The more eggs you have in the ovaries, the higher will be your AMH levels. Both of them will gradually decline through your reproductive years and become almost negligible by menopause.
Besides providing an insight into your fertility status and ability to get pregnant, the AMH hormone test may also help diagnose menstrual problems, ovarian cancer, etc.
AMH is also known as Müllerian-inhibiting hormone (MIH), Müllerian-inhibiting substance (MIS), Müllerian inhibiting factor (MIF).
What is the use of AMH?
At birth, a female has over a million eggs in her ovaries, but they decline to around half by the time she hits puberty. After that, the count keeps going down with advancing age. Every month, one out these thousands of eggs will undergo maturation and be released during a woman’s menstruation cycle.
The level of AMH in your blood is a reflection of this follicular maturation. It is often done along with other hormonal tests—estradiol and FSH.
In conditions like polycystic ovary syndrome (PCOS), multiple follicles are developed and this leads to abnormally high levels of AMH.
Typically, AMH levels indicate the number of potential eggs you have left, and this is known as your ovarian reserve.
If the ovarian reserve is good, you may be able to postpone pregnancy or egg freezing, but if it is low, you will be advised to quickly plan your pregnancy or freeze your eggs for future use.
When should you do the AMH test?
The AMH test is recommended if:
- You have difficulty conceiving
- You want to check your ovarian reserve before IVF
- You have menstrual disorders, amenorrhea, menopause
- You have symptoms of polycystic ovarian syndrome (PCOS) such as acne, reduced breast size, weight gain, excessive hair growth
- You are getting treatment for ovarian cancer
AMH testing details
When to get tested?
AMH levels do not vary with your menstrual cycle and the testing can be done on any day of the month.
Sample required?
Conventional labs will require a vial of blood from which they will separate the plasma to measure AMH but now you can also order at-home kits and test your AMH with a finger-prick.
Is there any test preparation needed?
The AMH test does not require you to be fasting or any other major preparation. If you’re taking birth-control pills, you must stop them a month or two before for accurate results.
How long do the results take?
It depends upon your laboratory. Some labs will give you the results within a day or two, while others may take upto a week.
How is Anti-Müllerian hormone test used?
AMH tests is used to:
- Check the ovarian reserve or fertility potential of a woman
- Predict the possible time of menopause
- Find the reason for early menopause
- Find the possible reason for lack of menstruation (amenorrhea) in young women
- Diagnose the presence of polycystic ovary syndrome (PCOS)
- Monitor certain types of ovarian cancer in women as AMH is significantly elevated
- Sexual differentiation of a baby. AMH levels can help identify intersex babies or those with incompletely developed genitals that are not clearly male or female.
What is the normal AMH levels in women?
The normal levels or AMH reference range for a woman under the age of 35 years is as below:
| > 4.0 ng/ml | High AMH (Often seen in PCOS) |
| 1.5-4.0 ng/ml | Normal AMH |
| 1.0 – 1.5 ng/ml | Low normal |
| 0.5 – 1.0 ng/ml | Low |
| < 0.5 ng/ml | Very low |
What are the average AMH levels by age?
| Age | Average normal AMH |
|---|---|
| Under 30 | > 2.9 |
| 30–34 | > 2.4 |
| 35–37 | 2.0 – 2.4 |
| 38–40 | 1.5 – 2.0 |
| 41–42 | 0.9 – 1.5 |
| Over 42 | < 0.5 |
What are the required AMH levels for IVF?
While this test does give an indication of the ovarian reserve and possible chances of success in IVF, do not panic if your AMH values don’t fall within the reference range.
AMH levels less than 1.5ng/ml are known to result in the retrieval of relatively fewer number of eggs but AMH under 0.7 ng/ml may result in poor responsiveness to controlled ovarian stimulation during IVF.
Extremely poor ovarian response is expected in AMH levels 0.1–0.35 ng/ml and there is a risk of cycle cancellation.
What if I have low AMH or diminished ovarian reserve?
It has been noted that IVF in women with very low AMH levels (under 0.5 ng/ml) has relatively poorer prognosis and higher chances of cycle cancellation. However, there is no reason for the patient to not try and pregnancy may still be achieved.
Eventually, you need one perfectly-matured, good quality-egg to be fertilized well into the perfect blastocyst embryo and we have known women with AMH as low as 0.3ng/ml, who were able to conceive with IVF.
Low AMH levels mean you may be starting menopause and will have trouble getting pregnant.
If you’re considering IVF in low AMH situations, your doctor may suggest any of the below treatment approaches:
- Lupron flare protocol for ovarian stimulation in IVF
- Assisted hatching
- IVF with donor eggs
What if I have high AMH?
Elevated AMH levels are usually an indication of PCOS. In this condition more than a few follicles mature in every monthly cycle resulting in higher amounts of AMH.
Some ovarian cancer that produce this hormone also result in elevated levels of AMH. Once the cancer treatment is started, AMH levels serve as an indicator of its efficacy.
For more information about Anti-Müllerian hormone testing and to consult with an experienced fertility expert for your fertility testing, get in touch using the red contact button. *t&c apply.
References
Revelli, A., Biasoni, V., Gennarelli, G., Canosa, S., Dalmasso, P., & Benedetto, C. (2016). IVF results in patients with very low serum AMH are significantly affected by chronological age. Journal of assisted reproduction and genetics, 33(5), 603–609. https://doi.org/10.1007/s10815-016-0675-7
Nelson, S. M., Yates, R. W., & Fleming, R. (2007). Serum anti-Müllerian hormone and FSH: prediction of live birth and extremes of response in stimulated cycles–implications for individualization of therapy. Human reproduction (Oxford, England), 22(9), 2414–2421. https://doi.org/10.1093/humrep/dem204